Research is a key component of any health system. So, when it comes to serving rural areas, how do these systems reach patients and populations that may otherwise be left out of the research process?
Research is a key component of any health system. So, when it comes to serving rural areas, how do these systems reach patients and populations that may otherwise be left out of the research process?
Valerie Schremp Hahn, Associate Editor of Catholic Health World, and Amy Elliott, PhD, the Avera Research Institute’s Chief Clinical Research Officer, join Health Calls to discuss Hahn’s recent article covering Elliott’s work for Avera’s mobile research lab. Elliott walks through the process of funding the lab, the challenges of operating it and how being on the road brings a wealth of opportunities to rural communities.
Read the Catholic Health World Article "Avera mobile lab brings researchers to rural communities."
Brian Reardon (00:00):
Hey, Val.
Valerie Schremp Hahn (00:01):
Hey Brian.
Brian Reardon (00:02):
Welcome to Health Calls. I think this is your first podcast episode with
Valerie Schremp Hahn (00:05):
Us. This is my very first time with you all.
Brian Reardon (00:08):
And so just so our listeners get a sense of who you are and what you do, you are an associate editor for CHW and you got a nice background in journalism.
Valerie Schremp Hahn (00:16):
Yes. Yes. I've associate editor with Catholic Health World, and I started with CHA in June. And previous to that I was a reporter for the St. Louis Post-Dispatch for more than 26 years. And I covered a variety of beats. So this is just a new way to tell stories and help people in communities
Brian Reardon (00:35):
And love to hear your voice and how people can put a voice with your byline.
Valerie Schremp Hahn (00:38):
That's right. I guess you got to look me up to see my face with the byline, but yeah, I'm out there.
Brian Reardon (00:45):
Well, we're going to talk about Researching on the Road with Avera Health. You want to get going?
Valerie Schremp Hahn (00:49):
Yes, let's do it.
Brian Reardon (00:55):
This is Health calls, the podcast of the Catholic Health Association of the United States. I'm your host, Brian Reardon. And as mentioned, we're joined by Valerie Schremp Hahn. An associate editor with the Catholic Health World. Again, welcome Val. Thank you. So in a moment, we're going to bring in Amy Elliott. She's PhD, Chief Clinical Research Officer for Avera Research Institute. We'll bring her in a couple of minutes, but I think to start with, let's get a little context about this article. Again, this was an article that appeared a couple of issues ago in CHW and I thought it was interesting. It's related to, and I think the title is a Avera Mobile Lab brings research to rural communities and it's an interesting approach to clinical research. So how did this come across your assignment desk, so to speak?
Valerie Schremp Hahn (01:39):
I basically was looking on their social media feeds. I was looking on social media feeds for different health organizations that we cover, and I saw that they put some posts up about their new mobile lab, and I thought that was kind of interesting. And they tried to make it fun when they reach kids. They had a little stuffed buffalo mascot named boom boom. And so I thought, oh, that's kind of cool. There's some interesting creative people behind that and gave 'em a call.
Brian Reardon (02:03):
And I think this story is interesting. Mobile outreach is nothing new. I mean, we see mobile mammograms and other covid, obviously there's a lot of mobile, but we're going to get into the uniqueness about this. But what struck you, I guess, as unique about this story, other than the Buffalo mascot.
Valerie Schremp Hahn (02:18):
Right? Yeah, I'm kind of a sucker for that kind of thing, but just the idea of blazing the trail and going out to people and just the fact that our research institute was behind it. It was just a different way to reach people and do their work.
Brian Reardon (02:33):
Yeah, it's unique and innovative and that's what we love. So let's go ahead and bring in Dr. Amy Elliott again. She's the Chief Clinical Research Officer for Avera Research Institute. Amy, welcome.
Amy Elliott, PhD (02:46):
Thanks for having me.
Brian Reardon (02:46):
Yeah, great to have you on Health Calls. So I guess I'll ask you the similar question I asked Val, is how did this mobile research unit come about?
Amy Elliott, PhD (02:55):
It's something that had been on the wishlist for quite a while, and I think of the things that covid taught us is that both research and healthcare need to change a bit of a mindset and be able to go where people are rather than always expecting them to come to us.
Brian Reardon (03:10):
Definitely. And I understand there was a grant that was behind this, so you got some funding that was able to support it.
Amy Elliott, PhD (03:16):
Yes. We have been part of the National Institutes of Health ECHOprogram, which stands for Environmental Influences on Child Health Outcomes. And we've been part of that network for about eight, nine years. And an opportunity came to write a supplement for this mobile unit so that we could start taking research to people.
Brian Reardon (03:36):
Tell us just a little bit about the unit itself, how it operates, how often does it go out? And it's again tied to a much larger research center, correct?
Amy Elliott, PhD (03:46):
Yes. Yeah. The Avera Research Institute, we have about 40 active projects going on with around 85 FTE located in offices across the state of South Dakota. And the mobile unit actually has two separate rooms, one that can be used for everything from blood draws, interviews with families, developmental assessments. The other room is set up for clinical exam or any kind of medical procedure that would be appropriate to do in such a setting. And so for research, it really keeps us, it gives a wide range of options where we can use it both for observational studies to see how kids are developing and growing, which is really what the ECHO program is helping look at. But it also could help serve for clinical trials to help bring cutting edge treatments out to especially our rural areas.
Brian Reardon (04:44):
And Val had mentioned she saw this on social media. As you're recruiting participants in these clinical studies, is outreach involved things like social media? How do you get people to know, Hey, this mobile unit's come into town and you might be interested in participating?
Amy Elliott, PhD (05:00):
What's been kind of fun about it is right after we got it for about the first six months, we really spent the majority of the time going to health fairs and powwows and other just kind of local community events. And I think what that served to do is it really got people interested. It was things they hadn't seen in their area before or coming to them. And we had just lines of people wanting more information and wanting to see. And again, the mascot that Valerie mentioned as well really draws a lot of people in for recruitment. For our studies, we do it through a whole variety of different means. Sometimes it's right through the health system with physicians helping identify patients that may be eligible for certain studies to community-wide output or enrollment where we just put out the word that we're enrolling in this study and this and people can call for more information.
Brian Reardon (05:57):
And in the article that Val put together, I think what's interesting and what caught my attention on this is really that, yeah, it's a research unit, but just in addition to, I guess from being a way to do research, it's also being used as a tool to increase equity is related to Vera's research and care. Can you talk a little bit about the equity piece of this?
Amy Elliott, PhD (06:23):
One of our basic tenets is we don't want people's zip code to dictate their health. And right now, your zip code is one of the things that's most closely tied to healthism. And so to try to help combat some of that with clinical trials in particular, you're really bringing, that's really where cutting edge treatments happen. And to give access to those clinical trials as well as making sure that our area is strongly represented in national type studies where interventions are developed, where policy is made is really important. And oftentimes our area and especially our rural and frontier footprint really get ignored.
Brian Reardon (07:08):
No, good point. And so tell us a little bit about the, I guess demographics. Obviously the Dakotas are very rural, our tribal communities I imagine are part of this effort of outreach.
Amy Elliott, PhD (07:19):
Oh, definitely. We've partnered with tribal nations for many, many years. In fact, have an office on the Oglala Sioux Tribe Reservation, which is our largest tribal nation located on the Pine Ridge Reservation. We've had an office there for, I've had one for over 20 years. And so close partnership with all the tribes. The tribes have really invited us in, which is a key to working with tribal communities to help on a whole variety of things. Looking at things like water quality even and how that may affect health.
Brian Reardon (07:54):
You mentioned at the outset that focus on pediatric studies. Can you talk a little bit about some of the studies that you're doing with kids?
Amy Elliott, PhD (08:01):
Sure. The ECHO program that I mentioned earlier that really served as the impetus for us to get this mobile unit has a lot of different focus areas. We actually start enrolling during pregnancy and then we'll follow the kids as long as we have funding, which is we're now going into our eighth year. We have 3,500 kids across our region, currently enrolled and are hoping to enroll another 1500 and just receive funding not that long ago for the next seven years. Things that study's looking at in particular, there's five major outcome areas, including things like asthma, obesity, positive health, neurodevelopment, which would include things like autism or attention problems. And then also outcomes related to the perinatal time period, that time period right around delivery.
Brian Reardon (08:52):
And this again feeds into national studies. And can you talk a little bit about how that works and how important that is, again, to have these more rural populations represented?
Amy Elliott, PhD (09:03):
Yes. So the ECHO project has sites across the country will result in about 50,000 kids enrolled. So by the time it's said and done will have close to 10% of the enrollment in that study right from our own region, which is almost unprecedented that there's such strong representation from the Midwest. A lot of times you see the big study sites for things like that along the coast and the middle of the country not as well represented. So we're really excited that we can bring that viewpoint and also bring our participants, but then also our physicians and scientists that are working this area to that national stage.
Brian Reardon (09:46):
In the article, and I'll quote a little bit of this, I thought this was an important point to bring up as well, is that some of these studies involve asking really personal questions and it may be about drug addiction or mental health. And you talk about how that can be a challenge. How is bringing a mobile unit to a community helpful in that engagement?
Amy Elliott, PhD (10:07):
Yeah, our participants, they amaze me all the time in their willingness to share in the hopes of helping others. And when you look at things as complex as health, there are very sensitive areas that are though very relevant for us to be able to answer some of the important complex questions. And I think bringing mobile units out to people shows a sign of respect that we are not just, they're passively just waiting for them to come to us, but that the effort is being made to go out, to seek people out, to make it as convenient as we possibly can for them. And I think it's a sign of respect that is appreciated. And some people really, like I said, they're responding very, very well to it. And the kids are so excited to go into this unit. So we've been also using it just to promote interest in science. So there's been so many different positive outcomes that have come from us just driving that rig around the area.
Brian Reardon (11:14):
Any downside or any challenges that you've faced with this?
Amy Elliott, PhD (11:17):
Well, the price of gas.
Brian Reardon (11:19):
Oh, good point.
Valerie Schremp Hahn (11:20):
I was wondering what kind of gas mileage this thing gets.
Amy Elliott, PhD (11:24):
The gas mileage is not great, but it's worth it. And we're getting it incorporated in more budget. So getting things covered all the time. I'm kind of laughing as I'm saying it, but it's actually kind of a real thing. The other challenge that has been for us is it's got water lines. And so in the winter there's specific upkeep that's needed. I think we got all that figured out now, just some of the logistics associated with it. The Avera health system, we clinics and hospitals all over the region, and so we've always got a place to park it. So that has not been a problem.
Brian Reardon (12:01):
But again, your point is that you're going out to people as opposed to saying, Hey, come to our facility. That's really the advantage. And so I guess there really isn't any pushback as you're rolling into different towns. They're welcoming it.
Amy Elliott, PhD (12:14):
Yeah, exactly. And we'll go to a more common area. So maybe people have to drive just five miles rather than 200 miles that it would take for them to get to Sioux Falls here, which is where my home base is. And then we also can take it right to homes if they're okay with that.
Brian Reardon (12:31):
Oh, interesting. So I think this model, it's interesting, that's why we're talking to you. So for other CHA members in particular, because that's our audience here, what advice would you have, and if someone was interested in doing this within their system, if they're doing research, any tips you want to share?
Amy Elliott, PhD (12:48):
One of the things that COVID really taught us is that we have to think a little differently sometimes about how we give care and how we think about how patients access care and access to health research is included in that. And one of the things that we found is there's a lot of creativity and approaches to that, which this mobile unit being one of them. And you're right, it's not used much in the research space. And we're really excited to be able to do that. And I think really just kind of thinking outside of the box, but listening to what your patients and participants need, what they're looking for and how is it that maybe we don't always do things the way we've always done them. How do we better help meet their needs?
Brian Reardon (13:35):
You've heard the conversation. I want to bring you in and just see if you have questions or comments for Amy. Well, I'm
Valerie Schremp Hahn (13:40):
Well I'm just kind of curious, what are the health needs of the people in your community? What kind of issues are you dealing with? What do you want to learn about and try to tackle and help with?
Amy Elliott, PhD (13:50):
Oh.
Valerie Schremp Hahn (13:50):
I'm sure a lot.
Amy Elliott, PhD (13:53):
Yeah. No, it's a really good question. We have studies going on right now all the way from defining long covid in children and adults, which is, even though it doesn't happen very often in kids, but when it does and with adults as well, it can be extremely debilitating. And so we've got those types of issues. Other ones that we're looking at is how do we do, for example, monitoring of hypertension for women after delivery? How are we able to do some of that longer term monitoring using remote monitoring devices, again, which we may be dropping off with our mobile unit as well as doing some education on. And so the other just, and I would be remiss if I didn't speak specifically about American Indian Health. The life expectancy just give you an idea for American Indians in our state is 20 years less than it is for the white population in our state. And that is a travesty and speaks to so many deaths happening during infancy, childhood, early adulthood that are driven by a lot of very, very complex factors. But when we're invited in specifically by tribal nations to help look for different things, I sure hope anyone would rise to the challenge in the call.
Brian Reardon (15:26):
Well, this is very, very interesting project, and I love you sharing some of the insights and how this came about and tips for others who may want to replicate this. Anything else you want to add? Any final words?
Amy Elliott, PhD (15:39):
One of the other things, when you're designing a mobile unit, you can have enough storage. So again, sometimes things come down to the logistics, but I tell you, the team is having so much fun and bringing things out to people, especially in this era where there's a lot of things around science and health that are getting questioned. True, true. How do we help keeping an open, transparent conversation with people so that they can ask us the tough questions, which they should be, ask us the tough questions, and also see how the sausage is made so that it's transparent. It's not this mystical process that happens. And I think by bringing research out to people, we're helping demystify and hopefully taking away some of the fear that can be associated with health research.
Brian Reardon (16:32):
Great point. Well, again, Amy Elliot PhD, Chief Clinical Research Officer for the Avera Research Institute. Thanks for taking a few minutes out and sharing some more insights on this program.
Amy Elliott, PhD (16:45):
Oh, thanks so much for your interest.
Brian Reardon (16:47):
And for Valerie Schremp Hahn an associate editor for Catholic Health World. I'm Brian Reardon, your host, and this has been another episode of Health Calls, the podcast of the Catholic Health Association of the United States. You can listen to and download Health Calls on all your favorite podcast apps, and of course, through our website, chha usa.org. You can also access the article, Avera Mobile Lab Brings Research to Rural Communities. There'll be a link on our podcast page to that article for Josh Matejka, our producer, and Brian Hartmann, our engineer here at Clayton Studios. Thanks for listening.